Monday, June 28, 2004

A good week

I haven't posted in a while. But it's been a good week. On the recovery front, my dad has been progressing well. All tubes have been removed (still has the catheter) and he's been breathing on his own. It now seems like he's going to be able to leave the hospital soon and enter a nursing facility, at least for a while. He's been progressing with the physical therapy (even though it really wears him out), and for the first time in a long time, it doesn't look like he's a moment away from backsliding.

My cousin came from out of town just to visit my dad, and came to the hospital Friday, Saturday, and Sunday to see him. I think my dad was really glad to have the extra company. Earlier in the week, one of the guys who had worked for my father back in the 1950's and 1960's came to the hospital to visit. It was like they had just talked the previous day. It sure must be nice to be a good person and have so many friends.

My cousin came from out of town just to visit my dad, and came to the hospital Friday, Saturday, and Sunday to see him.

On Saturday night, my cousin and I decided to take in a baseball game at Comerica Park, home of the Detroit Tigers for the past three seasons. It was my first visit there, so I took way too many pictures. The game turned out to be very exciting, with the home-team pulling it out with a homerun in the bottom of the 9th inning. Who could ask for more.

A picture of the main scoreboard at Comerica Park

My first trip to Comerica - it's a cool stadium with good views in every seat

Despite being in the second tier bleachers, just outside the foul post, the view was unobstructed

My cousin, sitting in the stands at Comerica Park

It looks like my cousin was enjoying the game

It was really good seeing my cousin after so many years. Though we talk on our birthdays, it's just not the same as seeing eachother in person. Despite the reason for his visit, everything was very upbeat, and I hope I get the opportunity to see him again real soon.

Monday, June 21, 2004

Recap in Pictures

I've given it some thought, and decided pictures would be appropriate.

When I first posted about the minor surgery, it seemed my dad would be home in a matter of days.

Dad on the day of his minor surgery

As you can see from the picture, he didn't seem any worse for wear, considering his age.

Within days, he had developed a reaction to the antibiotics administered as part of his post-op care, and while doctors struggled to figure out what was going on, he had begun the process of slipping into a near-death state as the SJS took hold of him. He looked like he had been in a fire... his skin was blistering all over, both externally and internally. Deep red rashes were evident on his torso, arms, legs, face, and scalp. The inside of his mouth was raw and bleeding. These were the days when I could barely stand to look at him, for fear my shock and horror would be telegraphed to him. Mercifully, I have no pictures from this period, although the picture below is representative of his condition.

A patient suffering from SJS shows the rash on arms, neck and torso

After nearly a month of treatment, my dad had been progressively getting better. However, it wasn't all good news... Not only was he suffering from SJS, but he had contracted pneumonia and septicemia. And after the steroid treatments were stopped, the SJS started to make an immediate comeback. Then, the doctors decided to try a blood transfusion. He seemed to make a nearly miraculous recovery.

This picture was taken the same day he had the blood transfusion

After the transfusion, he seemed to perk up a bit, though the receding SJS rash is still evident.

In this picture, if you look closely at his neck, you can see the bright red rash that had completely engulfed his body. Around his mouth are the remnants of sores and dried blood that had come from his internal bleeding. Still, I took this picture because it represented a monumental improvement from his condition over the previous two weeks.

Little did I know that within four days of taking that picture, my dad would be having what we thought were his last moments on earth. And just three days later, we again thought it was the end.

Somehow, he keeps fighting back, and today, we got to spend Father's Day with him. As you can see from the pictures below, he's on the mend again.

My dad listens as I read him the Father's Day card my wife and I gave him

When I looked at this picture afterward, I could tell how alert and attentive he had been.
It made me so happy.

A picture of my mom and I flanking my dad

My dad looked pleased that we were there to celebrate Father's Day with him.

Mom being cheeky with my resting dad

Lending a cheek, my mom gets cozy with dad.
At the time, he seemed to be more interested in getting some sleep.

And I couldn't do it without the support of my wife, seen here posing with my mom.

And of course, my wife (posing with my mom) was there to help lend support to me and my dad.

Sunday, June 20, 2004

Visiting my dad

So, we visited the hospital today for Father's Day, and saw my dad out of bed, relaxing on a reclinable wheelchair. While he sounded weak and had oxygen being administered through his nose, he was a bit more chipper than I've seen him. I took the opportunity to read aloud the card we had purchased, and into which I had pasted a personal note (printed from my home computer to look like it was part of the original card). He didn't seem at all depressed today, though he was a bit uncomfortable in the chair and asked for the nurse to do something or other every five minutes. I guess he's going stir crazy in the hospital. Who can blame him.

I'm of two minds whether to post pictures that show him in less than perfect health. On the one hand, the pictures may not be too pretty. On the other, it gives my family members who live out of town a chance to see my father in a condition better than when they last saw him. I'll have to give it some thought.
Father's Day weekend

My father's day weekend started early, with a family trip to honour my wife's dad. We invited her parents for a day out at Colasanti's in Leamington. I think the last time we visited there was last mother's day. Anyway, the day was very enjoyable. On the way there, I phoned my own dad at the hospital. I was so impressed with his recovery. For the first time in several weeks, he sounded like he had some energy. His voice sounded strong and intelligible. I should explain that last point... my dad has been very weak and during part of his treatment, he has been receiving nourishment through IV's. In that time, he hasn't had much liquid through his mouth, so his tongue and throat have been somewhat dry. This made it difficult for him to speak intelligibly. It sounded like when you're in the dentist chair with your mouth open and you're trying to make yourself understood. For someone with a trained ear, you can be understood, but to someone who isn't used to it, it's difficult to understand.

Anyway, I had no trouble understanding what he was saying. I told him I'd try to make it to the hospital on Saturday, but the day in Leamington went on for quite a bit longer than I originally thought it would, so there was just no time to visit my dad. Sunday (father's day proper) will be my opportunity to see him.

My cold symptoms had been pretty much receding until moments ago. I have just now started getting a bit of a runny nose. I don't know if it's because I haven't slept in quite some time, or if I still have the remnants of a cold. I so desperately want to see my dad, I think I'll just ask for a mask before I enter the room.

Thursday, June 17, 2004

Out of ICU

I've been at risk of a cold for the last few days, seeing that my wife showed symptoms a week ago. Late Tuesday night, I finally started showing symptoms of my own, so I've been staying away from the hospital since yesterday. My dad is out of the ICU and back in a room. When I called him this morning to say I may be able to visit in a couple of days, he said "I think I may be out of the hospital by then".

I'd like nothing more to see him healthy and out of the hospital, but what I don't want is to see him unhealthy and out of the hospital. I hope he continues to improve.

Tuesday, June 15, 2004

Where have you hidden my father?

The man in my dad's bed didn't appear to be the same person I've grown used to seeing over these past weeks. The man I saw yesterday was awake, alert, and had an appetite. He had no SJS rash, no noticeable breathing impairment. In addition, he had a voice and wasn't shy about using it. I tried to help him take a drink, only to be rebuffed so he could do it himself. When I casually remarked to a nurse that he might need physical therapy to recover lost muscle tone, he made a mock fist to "punch me in the nose" - a clear sign that the spirit had begun to return.

When I left him last night, it was just after the nurse had taken his vital signs. Except for a bit of continuing "crackle sounds" in the lungs, all were in the "healthy" range, including his blood-oxygen level, which was at 95% without aid of oxygen or a blood transfusion. With signs like this, I think they'll be transfering him back to a hospital room sometime soon. I only hope he gets the same level of attention he got in the ICU, since it's this extra level of attention that I'm sure is responsible for this second miraculous step back from the brink.

Sunday, June 13, 2004

Good news?

The colonoscopy was done Saturday morning. The good news was that there was no source of bleeding found in the colon. The doctor said that the scope only shows the main path through the colon and is unable to show the diverticula. So, the surgeon believes my dad's bleeding may have come from there.

From the referenced website:

... diverticula follow the paths of the arteries as they penetrate the muscle layer of the colon wall. Uncommonly, these same arteries can erode through the thin wall of the diverticulum and cause a major hemorrhage. This usually occurs when a person is elderly. The earliest symptoms are faintness and the appearance of much bright red blood by rectum.

That pretty much describes the colour of the blood we were seeing when he was bleeding. Overnight, my dad maintained good vital signs and experienced no bleeding. The doctors still want to perform an angiography to find the source of the bleeding, but that procedure only works when bleeding is present and profuse. I guess as long as my dad's condition continues to improve, I should be grateful.

Friday, June 11, 2004

Girls are Pretty

Eva's got a blog list that includes Girls are Pretty. The author is not shy at all and uses language that might offend some readers, but it's an interesting read.
Deja vu

Another frantic call. Another trip to the hospital at breakneck speeds. Another set of final goodbyes. Somehow the wires got crossed. Apparently there was a test that could have been performed between the last time my dad was bleeding and today, when he started again. Some mixup as to whether consent had been given appears to be the reason the test was not performed. Now, the test is riskier (after the latest trauma to my dad's battered body); yet conversely more likely to yield positive results (due to the additional blood-letting). When I left him, they were prepping him for a colonoscopy by feeding him massive dosages of fluids. It will wash out his system in preparation for the test. Once we get the results of the test (scheduled for tomorrow morning), we'll know whether surgery is needed.

He's bleeding again.
Moonlight Serenade

We did something different last night. My sister, who normally takes the "day shift" at the hospital, wanted a return visit. She asked whether we could go together. With just her and me at the bedside, I decided to give an impromptu rendition of songs I performed as a child (either at my Bar Mitzvah, or at elementary school plays). For some perspective on how long ago all this was, please remember I'm now a grandfather. Anyway, here I am, recalling the words to songs not sung for over 40 years, and my sister joins me (just as she did at my Bar Mitzvah).

Back then, "Mary Poppins" was just being released, and my sister and I had entertained the Bar Mitzvah guests with our renditions of songs from the movie. Though my singing voice has long since become unbearable, performing for my father seemed to be just the medicine he needed. He smiled (both with his mouth and eyes), and his humour was quite evident, as he remarked that my singing was providing him the opportunity to produce several satisfactory bowel movements.

Whether that means he was using the "music" as a cover for his bodily sounds, or whether he was politely saying I sang like shit, I don't really know. What I do know is that my sister and I had fun, and my dad seemed to enjoy the show.

After returning home, I spoke with my other sister (who was only 5 years old during the Bar Mitzvah gig), and she told me she had considered doing the very same thing earlier today when she had visited! Perhaps for tomorrow's visit, she'll add her two cents, thus completing the serenade.

Wednesday, June 09, 2004

Hang in there!

It's a miracle. The bleeding stopped, all on its own. It was the only scenario the doctors didn't believe would happen, although they had said, theoretically, that it was possible. So, my dad is out of the ICU, not going to have tests, or an operation, and is back in recovery immediate danger, but is still being kept in the ICU for observation and possible further testing.

Hang in there, pops!
Extraordinary measures for an extraordinary father

A few days ago, while my dad was being treated at the hospital, we felt it would be appropriate to broach the subject of extraordinary measures. Should things digress to the point of no hope, would my father want us to do everything possible, including the use of machines, to keep him going. He's a proud and strong man, despite his current condition, and, to no-one's surprise, he indicated heroic measures would not be necessary.

Today, minutes before I was to leave home to visit the hospital, my mom called me. She was crying hysterically, and said that I needed to get to the hospital right away. I had been talking with my sister when the phone rang, so when I got back to her, we decided to go together to the hospital. My dad had bled out, and was being kept alive by massive blood transfusions. We rushed to the hospital.

By the time we got there, my dad had been disconnected from the blood supply, but was still alive. The on-duty doctor explained that his bowel was probably ruptured, his blood pressure couldn't be maintained for very long, and he prepared us for the end. There was, he said, a slim possibility of prolonging his life with surgery, but the prognosis was not good. Again, we put the question to my dad about the possibility of surgery, and again, he said he had had enough. As he began to slip away, I placed a call to my sister in Toronto, hoping that somehow, she would be able to get down here in time to say goodbye. We also called the rabbi.

Within a half hour, my dad's blood pressure had dropped to the point where he needed to be transfered from the ward to the ICU. In the ICU, where they are better equipped to deal with such outbreaks, they started a couple of new lines from which they could infuse blood into his system more quickly. The standard veins in his arm had collapsed, as had one lung. Renal function was severly decreased, and oxygen levels were falling to critical levels. Blood pressure was now being reported in grim terms.

The doctors' efforts in the ICU were unbelievable. Within an hour, they had stabilized him to the point where the family could once again come to his side. Except for my sister, who was still making her way in from Toronto, the entire family was at the bedside, including some very close cousins whom we had contacted from the hospital. The ICU doctor gathered the family to discuss options. None were particularly good, although he made it clear there were still options available to us to try to extend my dad's life and give him one last chance at recovery. Being fully aware of my dad's intentions, we initially balked at any heroic measures. We were leaning more toward providing a sedative that would allow my dad slip quietly away in his sleep. But then, we started to think about the options. As described, although they weren't particularly optimistic, the doctors did indicate that if they could determine the cause of the internal bleeding, and if the damaged tissue was relatively localized, there was a chance that his life could be saved. With much help and physical therapy, my dad might once again enjoy a quality of life that would be worth the effort.

Our family approached his bed in the ICU. By now, he had blood being fed from three separate lines, and oxygen was also being administered. We could see the monitors showing a lower than ideal rate for blood pressure, respiration, and pulse. Oxygen levels were all that was acceptable, and that was due to the massive blood transfusions. We explained to my dad what the doctor had told us... that without further treatment, he would be gone by morning; and that with treatment, there were no guarantees. We told him he'd need to be placed on a ventilator soon, to preserve his respiration and reduce the need for the blood, which, while keeping him alive, was complicating the efforts to keep him breathing. We told him that after some tests were run, he might have to have surgery to repair his bowels, or that his bowels may completely die and have to be removed. We told him he might have to use a colostomy bag for the rest of his life. Most of all, we told him that we all loved him, and weren't prepared to say goodbye if there was even a chance that he could be saved.

Finally, it was his choice to make. He looked at us all. And then he said "I want to fight". So now, we have a clear directive. The test will be done. Surgery will be performed if required. He may die tomorrow in the process, but it won't be because he gave up on life, or because we allowed ourselves to give up on him.

Monday, June 07, 2004

A discouraging word

Dad's progress is slipping. I was there for a couple of hours today, but even though he saw me for a minute or two, I doubt he remembers I was there. He was quite lethargic when awake, and awake very little. He didn't seem like his rash had gotten any worse, but then again, when someone appears to be sleeping, rather than struggling to communicate, it's hard to know what's going on inside.

It's quite discouraging at the moment.

Saturday, June 05, 2004

Back to Earth

I spent several hours with my dad today. He wasn't the energetic man I expected to see, although he was able to feed himself, lift himself (with some help) from his chair to walk (again, with some help) to the bathroom, and spend more time sitting than lying down. It's an improvement, but according to the doctors, the SJS is still around and will need to be dealt with, and his course of antibiotics began again tonight.

I suppose that, compared to last night, he was still in better shape, but a far cry from what my sister had described to me this morning.

Oh well, I guess it was too good to last.

Friday, June 04, 2004

Boris and Natasha

I am blogging during working hours. Trust me, this post is worth it.

I remember watching Rocky and Bullwinkle as a child. Boris and Natasha were my favourite characters. The line "in with the bad air, out with the good" has always stuck with me. And today it's so apropos. In yesterday's visit to my father, I neglected to mention a couple of things. I didn't leave them out on purpose... they just slipped my mind.

My dad had a bone marrow test yesterday (results still pending), and he had a blood transfusion.

So, just now, I got a call from my sister at the hospital. Unbelievable. It had to be the transfusion. Take some good, clean wholesome blood, feed it to someone with low platelets, blood infection, and possible bone marrow disease, and what do you get? An 84 year old man who wants to get out of bed (for the first time in weeks), stroll around the hospital with a wheeled walker (the regular kind didn't go fast enough for his liking), go to the bathroom like a real man and start joking around like the man we all know he is!

Of course, I've seen this level of recovery before, and I'm not going to allow my spirits to be lifted too high until I see how long-lived this new condition will be. But now, at least, there is hope.

Now, I've got to get back to work.
Oh what fun

My blog uses a style sheet to display it's content, like most other sites on the web. In order to "jazz" the screen up a bit, I use a different colour and font to display my links when someone mouses over them. That's no big deal. But I just read my previous post (the Fantastic Idea) and tried to click on the link embedded in the story. I use IE 6, and 1024 x 768 1280 x 1024 resolution on my computer. When my mouse passed over the link, it changed to it's "mouse-over" font, which is somewhat smaller than when normally displayed. The change in font size was enough to make the link move to a different part of the screen, so that the mouse was no longer hovering over the link. Because of that, I was not able to activate the link! If I tried to "sneak up" on it, I was sometimes able to highlight it and stealthily move to the other part of the screen and re-click on the highlighted link, but most of the time, that darn link became quite illusive.

I wonder if anyone else who uses a different screen resolution has experienced this problem on my blog.

Updated to fix an incorrect statement about my screen settings
What a fantastic idea!

I think every child has done this at some point in their life... created a deck of flash cards with slightly different images, which, when the deck is fanned, appears to be a motion picture.

Some advertising company has used this premise to create "motion picture" advertising inside darkened train tunnels. As the train passes each lit advertising panel, part of the message is delivered, and over the course of the trip, the message unfolds in motion pictures.

Hmm, I wonder how that works when trains are travelling in the opposite direction?
Downhill Racer

Dad's taken a turn for the worse. His SJS is on the upswing, and the doctors are debating what his course of treatment should be. Some say he needs to get back on the steroids (which, in higher doses, had been effective in reducing the symptoms) for an indefinite period. Unfortunately, being on higher doses of steroids for an extended period has undesirable side effects, like mood swings and high blood sugar. Being on steroids would require that insulin injections be administered on an ongoing basis.

Other doctors are suggesting we begin treating him with suppressive drugs... those that suppress the rejection mechanisms of the body, and hopefully eliminating the sensitivity to the drugs that is causing the SJS. This course of therapy might make him more susceptible to infection, since his body would be less likely to fight the foreign body.

Neither course of treatment is particularly appealing, but things are getting pretty desperate. As my dad weakens, he loses his appetite and becomes listless. At times, the fighting spirit that's kept him going for so long seems to get dimmer. He swears he's not going to give up the fight, but it's really tough when everything you hear going on around you is discouraging.

There was one small victory today. He was breathing without aid of oxygen. Unfortunately, he was running a fever for much of the day, so that indicates to me that the infection may again be getting the upper hand.

Tuesday, June 01, 2004

Surprising turn of events

I suppose if I was a medical professional, I would know these things. Unfortunately, I'm not, so it came as quite a shock today when I visited the hospital and saw my dad with no IV tube. He's had a continuous stream of IVs for hydration and antibiotics, but they had been discontinued as of today. When I asked why, the answer was almost too obvious. It seems there is just as much danger in continuing antibiotic treatments for too long as there is in discontinuing them before you're supposed to. So, for a few days at least, my dad won't be receiving any medication beyond what he would take if he were at home.

He's still on oxygen, and that's good, because his chart indicated his oxygenation had become worse overnight. His blood-sugar is still very high, and it's believed the infection is the cause of that (since the diminishing doses of steroids were discontinued yesterday). The rash has gotten worse since the last time I saw my dad, although his face has totally cleared up. He was supposed to have a bone marrow test today, but the doctor didn't show up, so he'll have that tomorrow instead.

My dad was quite tired this evening, and hadn't eaten much during the day, although he did have a small glass of milk and half an ice-cream cup. Hopefully, his appetite will return tomorrow.